title: A systematic review of the use of Botulinum toxin type A with subpectoral breast implants.
abstract: OBJECTIVE
  To determine the efficacy of Botulinum toxin A (BTX-A) injections for pain relief following placement of subpectoral tissue expanders and breast implants.
  
  
  METHODS
  MEDLINE and EMBASE were searched from their inception to December 2012 to identify studies reporting the efficacy of perioperative BTX-A injections following breast surgery with subpectoral prostheses. Study designs included controlled and uncontrolled studies.
  
  
  RESULTS
  Seven studies met the inclusion criteria (2 prospective controlled cohort, 3 retrospective cohort and 2 case series). Five studies assessed the efficacy of BTX-A and three measured pain improvement as a primary outcome. The studies enrolled 427 women: 91.8% received intraoperative BTX-A injection at the time of tissue expander breast reconstruction and 4.7% following augmentation mammaplasty. Only 3.5% of women received BTX-A injections in the postoperative setting. Overall, all the studies demonstrated improvement in pain and favorable side effect profile without any major adverse effects. However, the quality of this evidence was low.
  
  
  CONCLUSIONS
  The results of this systematic review suggest that BTX-A may alleviate postoperative pain associated with the placement of subpectoral tissue expanders and implants. The available data on outcome assessment of this practice are inconsistent and lack methodological rigor. With paucity of high-level evidence to support this practice in implant-based breast surgery, further studies are needed.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Winocour
authors.affiliation: The Centers for Science of Healthcare Delivery and Translational Sciences Activities, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Bidgoli-Moghaddam
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Jacobson
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Uldis
authors.initials: U
authors.lastname: Bite
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Saint-Cyr
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Nho V
authors.initials: NV
authors.lastname: Tran
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: lemaine.valerie@mayo.edu.
authors.forename: Valerie
authors.initials: V
authors.lastname: Lemaine
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D019928:Breast Implantation / Q000009:adverse effects*; D018427:Breast Implants / Q000009:adverse effects; D005260:Female; D006801:Humans; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D015625:Tissue Expansion Devices / Q000009:adverse effects
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin A; Breast implants; Breast reconstruction; Postoperative pain; Tissue expanders